1
|
Merezhinskaya N, Bai AC, Park D, Barker Ii FM, Gu W. Characterization of Mild Traumatic Brain Injury Cohort With Photophobia From the Defense and Veterans Eye Injury and Vision Registry. Mil Med 2024; 189:736-742. [PMID: 39160895 DOI: 10.1093/milmed/usae251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/21/2024] [Accepted: 04/29/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Photophobia is a common visual symptom following mild traumatic brain injury (mTBI), which can adversely affect the military readiness and performance of service members (SMs). We employed the Defense and Veterans Eye Injury and Vision Registry (DVEIVR) to identify and describe a cohort of SMs diagnosed with photophobia post-mTBI. The objective of this study was to characterize comorbid conditions and symptoms in an mTBI cohort with photophobia, to assess their co-occurrence, to describe the persistence of photophobia, and to assess the effectiveness of utilization of currently available International Statistical Classification of Diseases and Related Health Problems (ICD) codes in reporting photophobia in this cohort. MATERIALS AND METHODS The DVEIVR database was searched to identify a cohort of SMs experiencing photophobia after mTBI. Photophobia and other potentially related conditions and symptoms, both coded and descriptive, which were abstracted directly from the medical records of SMs, were found within DVEIVR. The presence of the conditions and symptoms comorbid with photophobia was characterized on both patient and encounter levels. Analysis of co-occurrence of photophobia with these conditions or symptoms was performed on the encounter level using co-occur package in the statistical program R. Persistence of photophobia up to 1 year since the injury was assessed. The utilization of currently available ICD codes for photophobia was analyzed. RESULTS A total of 639 SMs exhibiting photophobia after mTBI were identified in DVEIVR. Headaches, including migraines, were the most frequently experienced comorbidity affecting 92% of the SMs in the cohort. The second most frequent complaint was dizziness and/or vertigo (53%) followed by nausea (42%), blurry vision (31%), and irritation and discomfort in the eye (17%). In all, 20% of encounters with photophobia had a complaint of headaches, followed by 8.3% of photophobia encounters co-occurring with dizziness and vertigo, 5.7%-with nausea, 4.5%-with blurred vision, and 2.1%-with subjective sensations in the eye. All comorbidities co-occurred with photophobia at probabilities higher than by chance alone. The percentage of mTBI SMs experiencing photophobia declined to 20% at 30 days after the injury, 17% at 3 months, 12% at 6 months, and 7% at 12 months post-injury, respectively. The use of currently available ICD codes for photophobia was very low-only 27.1% of the cohort had at least 1 ICD code recorded in their medical records. CONCLUSIONS The results of this study support the idea that there is a strong relationship between photophobia and headache after an mTBI. Additional research is warranted to better understand this relationship and its causes so that clinical management improves. The results of this study show a precipitous decline in the numbers of cases of photophobia after mTBI over the first 30 days and a longer-term persistence up to a year in a minority of cases, which is consistent with other research in this field. Various ICD codes, which are currently used to code for photophobia, along with other vision conditions, were not widely used to document photophobia symptoms. It is important to adopt a dedicated ICD code for photophobia to improve the surveillance, data collection, and analysis of this condition.
Collapse
Affiliation(s)
- Natalya Merezhinskaya
- Department of Defense/Veterans Affairs Vision Center of Excellence, DHA Research and Engineering Directorate, Walter Reed National Military Medical Center, Bethesda, MD 20889-5629, USA
| | - Abigail C Bai
- Department of Defense/Veterans Affairs Vision Center of Excellence, DHA Research and Engineering Directorate, Walter Reed National Military Medical Center, Bethesda, MD 20889-5629, USA
| | - DoHwan Park
- Department of Defense/Veterans Affairs Vision Center of Excellence, DHA Research and Engineering Directorate, Walter Reed National Military Medical Center, Bethesda, MD 20889-5629, USA
- Department of Mathematics and Statistics, University of Maryland-Baltimore County, Baltimore, MD 21250, USA
| | - Felix M Barker Ii
- Department of Defense/Veterans Affairs Vision Center of Excellence, DHA Research and Engineering Directorate, Walter Reed National Military Medical Center, Bethesda, MD 20889-5629, USA
- Kentucky College of Optometry, University of Pikeville, Pikeville, KY 41501, USA
| | - Weidong Gu
- Department of Defense/Veterans Affairs Vision Center of Excellence, DHA Research and Engineering Directorate, Walter Reed National Military Medical Center, Bethesda, MD 20889-5629, USA
| |
Collapse
|
2
|
Kerckhoffs J, Marzolla MC, Lytrokapi D, Wendker C, Thielen H, Gillebert CR, Winkens I, Blokland A. Objectifying subjective memory complaints: VR-based Verbal Word Learning Test in chronic stroke patients. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-9. [PMID: 38976764 DOI: 10.1080/23279095.2024.2366514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Memory impairment imposes a great burden on stroke patients and can be divided into Objective Memory Problems (OMPs) and Subjective Memory Complaints (SMCs). Studies have shown that these do not always co-occur. Possibly, the gap between SMCs and OMPs can be bridged when using a more ecologically valid memory test and considering the impact of other common stroke symptoms such as sensory hypersensitivity (SHS) and fatigue. In the present study, we applied Virtual Reality (VR) to create a sensory-rich environment with real-life stimuli. Memory performance was tested with the 15-Verbal Word Learning Test (VLT). Furthermore, we assessed SMCs (Everyday Memory Questionnaire), and the levels of SHS (Multi-Modal Evaluation of Sensory Sensitivity) and fatigue in the previous month. 31 chronic stroke patients and 32 healthy controls participated. The results showed that participants' memory performance decreased in a sensory-rich compared to a neutral environment. This decrease did not significantly differ between the groups. Interestingly, fatigue and SHS are related to the level of SMC in stroke patients but no such evidence was found in healthy controls. Last, for stroke patients, we found a significant negative correlation between SMCs and memory performance in a sensory-rich environment, but not in a neutral environment. In conclusion, our study implicates that in stroke patients, fatigue and SHS are related to SMCs and that using a sensory-rich VR environment might be a more ecologically valid way to objectify SMCs. However, interpretative caution is warranted due to the absence of sex and age-matched controls and potential selection bias.
Collapse
Affiliation(s)
- Jill Kerckhoffs
- Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| | | | - Danai Lytrokapi
- Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| | - Cyrella Wendker
- Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| | | | | | - Ieke Winkens
- Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| | - Arjan Blokland
- Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
3
|
Marzolla MC, Thielen H, Hurks P, Borghans L, van Heugten C. Qualitative data on triggers and coping of sensory hypersensitivity in acquired brain injury patients: A proposed model. Neuropsychol Rehabil 2024; 34:802-822. [PMID: 37616553 DOI: 10.1080/09602011.2023.2242616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/21/2023] [Indexed: 08/26/2023]
Abstract
Sensory hypersensitivity (SHS) is a frequently heard complaint after acquired brain injury (ABI) and is related to reduced quality of life and physical and mental health. This study aimed to identify triggers for SHS after ABI and investigate how individuals cope with SHS. Nineteen adults with ABI took part in 45-min individual interviews. Data were audio-recorded and transcribed verbatim. Inductive thematic analysis revealed five themes: (1) A mismatch between resources and demands, (2) Altered experience of ordinary stimuli, (3) It affects all aspects of living, (4) Avoid, approach, accept, (5) It's highly heterogeneous. A model explaining the impact of triggers on subjective SHS after ABI is proposed, which states that SHS arises from a mismatch between the demands of a sensory environment (triggers) and the available biopsychosocial resources of an individual to meet these demands. The elicited SHS can affect and be affected by levels of fatigue, which limits the resources and creates a loop. Coping strategies can act on various stages of this model, i.e., to reduce the mismatch and potentially alter the loop. This model can contribute to the identification of mechanisms behind SHS in ABI patients and other populations, ultimately leading to evidence-based treatments.
Collapse
Affiliation(s)
- Marilien C Marzolla
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
| | - Hella Thielen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Petra Hurks
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Lex Borghans
- School of Business and Economics, Maastricht University, Maastricht, the Netherlands
| | - Caroline van Heugten
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Limburg Brain Injury Centre, Maastricht, the Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
4
|
Thielen H, Welkenhuyzen L, Tuts N, Vangkilde S, Lemmens R, Wibail A, Lafosse C, Huenges Wajer IMC, Gillebert CR. Why am I overwhelmed by bright lights? The behavioural mechanisms of post-stroke visual hypersensitivity. Neuropsychologia 2024; 198:108879. [PMID: 38570111 DOI: 10.1016/j.neuropsychologia.2024.108879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/15/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
After stroke, patients can experience visual hypersensitivity, an increase in their sensitivity for visual stimuli as compared to their state prior to the stroke. Candidate behavioural mechanisms for these subjective symptoms are atypical bottom-up sensory processing and impaired selective attention, but empirical evidence is currently lacking. In the current study, we aimed to investigate the relationship between post-stroke visual hypersensitivity and sensory thresholds, sensory processing speed, and selective attention using computational modelling of behavioural data. During a whole/partial report task, participants (51 stroke patients, 76 orthopedic patients, and 77 neurotypical adults) had to correctly identify a single target letter that was presented alone (for 17-100 ms) or along a distractor (for 83ms). Performance on this task was used to estimate the sensory threshold, sensory processing speed, and selective attention abilities of each participant. In the stroke population, both on a group and individual level, there was evidence for impaired selective attention and -to a lesser extent- lower sensory thresholds in patients with post-stroke visual hypersensitivity as compared to neurotypical adults, orthopedic patients, or stroke patients without post-stroke sensory hypersensitivity. These results provide a significant advancement in our comprehension of post-stroke visual hypersensitivity and can serve as a catalyst for further investigations into the underlying mechanisms of sensory hypersensitivity after other types of acquired brain injury as well as post-injury hypersensitivity for other sensory modalities.
Collapse
Affiliation(s)
- H Thielen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - L Welkenhuyzen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department Psychology, Hospital East-Limbourgh, Genk, Belgium; TRACE, Centre for Translational Psychological Research (TRACE), KU Leuven - Hospital East-Limbourgh, Genk, Belgium
| | - N Tuts
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - S Vangkilde
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, Copenhagen, Denmark; Child and Adolescent Mental Health Center, Copenhagen University Hospital, Copenhagen, Denmark
| | - R Lemmens
- Experimental Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - A Wibail
- Neurology, Hospital East-Limbourgh, Genk, Belgium
| | - C Lafosse
- Paramedical and Scientific Director, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - I M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands; Experimental Psychology, Utrecht University, the Netherlands
| | - C R Gillebert
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium; TRACE, Centre for Translational Psychological Research (TRACE), KU Leuven - Hospital East-Limbourgh, Genk, Belgium.
| |
Collapse
|
5
|
Bigras C, Theodoroff SM, Thielman EJ, Hébert S. Noise sensitivity or hyperacusis? Comparing the Weinstein and Khalfa questionnaires in a community and a clinical samples. Hear Res 2024; 445:108992. [PMID: 38492447 DOI: 10.1016/j.heares.2024.108992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/25/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
Noise sensitivity and hyperacusis are decreased sound tolerance conditions that are not well delineated or defined. This paper presents the correlations and distributions of the Noise Sensitivity Scale (NSS) and the Hyperacusis Questionnaire (HQ) scores in two distinct large samples. In Study 1, a community-based sample of young healthy adults (n = 103) exhibited a strong correlation (r = 0.74) between the two questionnaires. The mean NSS and HQ scores were 54.4 ± 16.9 and 12.5 ± 7.5, respectively. NSS scores displayed a normal distribution, whereas HQ scores showed a slight positive skew. In Study 2, a clinical sample of Veterans with or without clinical comorbidities (n = 95) showed a moderate correlation (r = 0.58) between the two questionnaires. The mean scores were 66.6 ± 15.6 and 15.3 ± 7.3 on the NSS and HQ, respectively. Both questionnaires' scores followed a normal distribution. In both samples, participants who self-identified as having decreased sound tolerance scored higher on both questionnaires. These findings provide reference data from two diverse sample groups. The moderate to strong correlations observed in both studies suggest a significant overlap between noise sensitivity and hyperacusis. The results underscore that NSS and HQ should not be used interchangeably, as they aim to measure distinct constructs, however to what extent they actually do remains to be determined. Further investigation should distinguish between these conditions through a comprehensive psychometric analysis of the questionnaires and a thorough exploration of psychoacoustic, neurological, and physiological differences that set them apart.
Collapse
Affiliation(s)
- Charlotte Bigras
- School of Speech Audiology, Faculty of Medicine, Université de Montréal and Centre Interdisciplinaire de Recherche sur le Cerveau et l'Apprentissage (CIRCA), Québec, Canada
| | - Sarah M Theodoroff
- VA, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA; Department of Otolaryngology, Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Emily J Thielman
- VA, National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, OR, USA
| | - Sylvie Hébert
- School of Speech Audiology, Faculty of Medicine, Université de Montréal and Centre Interdisciplinaire de Recherche sur le Cerveau et l'Apprentissage (CIRCA), Québec, Canada.
| |
Collapse
|
6
|
Jotie JM, Gustafson JA, Fonda JR, Fortier CB, Milberg WP, Fortenbaugh FC. Association of mild traumatic brain injury, post-traumatic stress disorder, and other comorbidities on photosensitivity. Optom Vis Sci 2024; 101:90-98. [PMID: 38408306 DOI: 10.1097/opx.0000000000002104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
SIGNIFICANCE Photosensitivity is common after mild traumatic brain injury. However, this study demonstrates that photosensitivity is also impacted by common comorbidities that often occur with mild traumatic brain injury. Understanding how physical and psychological traumas impact photosensitivity can help improve provider care to trauma survivors and guide novel therapeutic interventions. PURPOSE This study aimed to characterize the association between mild traumatic brain injury and common comorbidities on photosensitivity in post-9/11 veterans. METHODS Existing data from the Translational Research Center for TBI and Stress Disorders cohort study were analyzed including traumatic brain injury history and post-traumatic stress disorder clinical diagnostic interviews; sleep quality, anxiety, and depression symptoms self-report questionnaires; and photosensitivity severity self-report from the Neurobehavioral Symptom Inventory. Analysis of covariance and multiple ordinal regression models were used to assess associations between mild traumatic brain injury and common comorbidities with photosensitivity severity. RESULTS Six hundred forty-one post-9/11 veterans were included in this study. An initial analysis showed that both mild traumatic brain injury and current post-traumatic stress disorder diagnosis were independently associated with higher photosensitivity ratings compared with veterans without either condition, with no interaction observed between these two conditions. Results of the ordinal regression models demonstrated positive associations between degree of photosensitivity and the number of mild traumatic brain injuries during military service and current post-traumatic stress disorder symptom severity, particularly hyperarousal symptoms, even when controlling for other factors. In addition, the degree of sleep disturbances and current anxiety symptoms were both positively associated with photosensitivity ratings, whereas depression symptoms, age, and sex were not. CONCLUSIONS Repetitive mild traumatic brain injury, post-traumatic stress disorder, anxiety, and sleep disturbances were all found to significantly impact photosensitivity severity and are therefore important clinical factors that eye care providers should consider when managing veterans with a history of deployment-related trauma reporting photosensitivity symptoms.
Collapse
|
7
|
Thielen H, Huenges Wajer IMC, Tuts N, Welkenhuyzen L, Lafosse C, Gillebert CR. The Multi-Modal Evaluation of Sensory Sensitivity (MESSY): Assessing a commonly missed symptom of acquired brain injury. Clin Neuropsychol 2024; 38:377-411. [PMID: 37291083 DOI: 10.1080/13854046.2023.2219024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
Objective: Sensory hypersensitivity is common after acquired brain injury. Since appropriate diagnostic tools are lacking, these complaints are overlooked by clinicians and available literature is limited to light and noise hypersensitivity after concussion. This study aimed to investigate the prevalence of sensory hypersensitivity in other modalities and after other types of brain injury. Method: We developed the Multi-Modal Evaluation of Sensory Sensitivity (MESSY), a patient-friendly questionnaire that assesses sensory sensitivity across multiple sensory modalities. 818 neurotypical adults (mean age = 49; 244 male) and 341 chronic acquired brain injury patients (including stroke, traumatic brain injury, and brain tumour patients) (mean age = 56; 126 male) completed the MESSY online. Results: The MESSY had a high validity and reliability in neurotypical adults. Post-injury sensory hypersensitivity (examined using open-ended questions) was reported by 76% of the stroke patients, 89% of the traumatic brain injury patients, and 82% of the brain tumour patients. These complaints occurred across all modalities with multisensory, visual, and auditory hypersensitivity being the most prevalent. Patients with post-injury sensory hypersensitivity reported a higher sensory sensitivity severity on the multiple-choice items of the MESSY as compared to neurotypical adults and acquired brain injury patients without post-injury sensory hypersensitivity (across all sensory modalities) (effect sizes (partial eta squared) ranged from .06 to .22). Conclusions: These results show that sensory hypersensitivity is prevalent after different types of acquired brain injury as well as across several sensory modalities. The MESSY can improve recognition of these symptoms and facilitate further research.
Collapse
Affiliation(s)
- Hella Thielen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Irene M C Huenges Wajer
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - Nora Tuts
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Lies Welkenhuyzen
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department Psychology, Hospital East-Limbourgh, Genk, Belgium
- TRACE, Centre for Translational Psychological Research (TRACE), Genk, Belgium
| | - Cristophe Lafosse
- Paramedical and Scientific Director, RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Celine R Gillebert
- Department Brain & Cognition, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- TRACE, Centre for Translational Psychological Research (TRACE), Genk, Belgium
| |
Collapse
|
8
|
Butler M, Abdat Y, Zandi M, Michael BD, Coutinho E, Nicholson TR, Easton A, Pollak TA. Mental health outcomes of encephalitis: An international web-based study. Eur J Neurol 2024; 31:e16083. [PMID: 37797295 PMCID: PMC11236046 DOI: 10.1111/ene.16083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND PURPOSE Acute encephalitis is associated with psychiatric symptoms. Despite this, the extent of mental health problems following encephalitis has not been systematically reported. METHODS We recruited adults who had been diagnosed with encephalitis of any aetiology to complete a web-based questionnaire. RESULTS In total, 445 respondents from 31 countries (55.1% UK, 23.1% USA) responded. Infectious encephalitis constituted 65.4% of cases, autoimmune 29.7%. Mean age was 50.1 years, 65.8% were female, and median time since encephalitis diagnosis was 7 years. The most common self-reported psychiatric symptoms were anxiety (75.2%), sleep problems (64.4%), mood problems (62.2%), and unexpected crying (35.2%). Self-reported psychiatric diagnoses were common: anxiety (44.0%), depression (38.6%), panic disorder (15.7%), and posttraumatic stress disorder (PTSD; 21.3%). Severe mental illnesses such as psychosis (3.3%) and bipolar affective disorder (3.1%) were reported. Self-reported diagnosis rates were broadly consistent with results from the Psychiatric Diagnostic Screening Questionnaire. Many respondents also reported they had symptoms of anxiety (37.5%), depression (28.1%), PTSD (26.8%), or panic disorder (20.9%) that had not been diagnosed. Rates of psychiatric symptoms did not differ between autoimmune and infectious encephalitis. In total, 37.5% respondents had thought about suicide, and 4.4% had attempted suicide, since their encephalitis diagnosis. More than half of respondents (53.5%) reported they had no, or substandard, access to appropriate mental health care. High rates of sensory hypersensitivities (>75%) suggest a previously unreported association. CONCLUSIONS This large international survey indicates that psychiatric symptoms following encephalitis are common and that mental health care provision may be inadequate. We highlight a need for proactive psychiatric input.
Collapse
Affiliation(s)
- Matt Butler
- Neuropsychiatry Research and Education GroupKing's College LondonLondonUK
| | - Yasmin Abdat
- Neuropsychiatry Research and Education GroupKing's College LondonLondonUK
| | - Michael Zandi
- Department of NeuroinflammationUniversity College London Queen Square Institute of NeurologyLondonUK
| | - Benedict D. Michael
- Department of Clinical Infection, Microbiology, and ImmunologyUniversity of LiverpoolLiverpoolUK
| | - Ester Coutinho
- Neuropsychiatry Research and Education GroupKing's College LondonLondonUK
- Center for Neuroscience and Cell BiologyUniversity of CoimbraCoimbraPortugal
| | | | - Ava Easton
- Department of Clinical Infection, Microbiology, and ImmunologyUniversity of LiverpoolLiverpoolUK
- Encephalitis SocietyMaltonUK
| | - Thomas A. Pollak
- Neuropsychiatry Research and Education GroupKing's College LondonLondonUK
| |
Collapse
|
9
|
de Sain AM, Pellikaan LWM, van Voskuilen J, Migdis M, Sommers-Spijkerman MPJ, Visser-Meily JMA, Huenges Wajer IMC. Sensory hypersensitivity after acquired brain injury: the patient perspective. Disabil Rehabil 2023:1-8. [PMID: 37649314 DOI: 10.1080/09638288.2023.2251401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE Sensory hypersensitivity is a frequently reported complaint after acquired brain injury (ABI). This study explores patients' perceptions of sensory hypersensitivity following ABI and its impact on everyday life. MATERIALS AND METHODS Semi-structured interviews were conducted with 18 patients with ABI (stroke, brain tumour, TBI) who reported complaints of sensory hypersensitivity. Interview data were analysed using qualitative thematic analysis. RESULTS Six themes emerged from the data: (1) definition of sensory hypersensitivity, relating to individual perceptions of sensory hypersensitivity; (2) type of sensory stimuli, relating to the variety of stimuli that patients may be sensitive to; (3) course, relating to changes in sensory hypersensitivity following ABI; (4) fatigue, relating to its association with sensory hypersensitivity; (5) consequences of sensory hypersensitivity, relating to the physical, social and emotional impact of sensory hypersensitivity on patients' lives; and (6) coping strategies, relating to behaviours used to cope with sensory hypersensitivity. CONCLUSIONS Sensory hypersensitivity can have a major impact on patients' physical well-being, return to work and (social) participation after ABI. Characteristics of sensory hypersensitivity vary between patients with ABI. To develop treatments for sensory hypersensitivity, future studies should focus on cognitive (e.g., filtering information) and psychological factors (e.g., coping) in relation to sensory hypersensitivity.
Collapse
Affiliation(s)
- A M de Sain
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L W M Pellikaan
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - J van Voskuilen
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - M Migdis
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | - M P J Sommers-Spijkerman
- Department of Rehabilitation, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Department of Rehabilitation, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I M C Huenges Wajer
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands
- Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
10
|
Daugherty J, Sarmiento K, Waltzman D, Schmidt J. Special Report from the CDC Healthcare provider influence on driving behavior after a mild traumatic brain injury: Findings from the 2021 SummerStyles survey. JOURNAL OF SAFETY RESEARCH 2023; 85:507-512. [PMID: 37330900 PMCID: PMC10440851 DOI: 10.1016/j.jsr.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Research shows that a mild traumatic brain injury (mTBI) impairs a person's ability to identify driving hazards 24 h post injury and increases the risk for motor vehicle crash. This study examined the percentage of people who reported driving after their most serious mTBI and whether healthcare provider education influenced this behavior. METHODS Self-reported data were collected from 4,082 adult respondents in the summer wave of Porter Novelli's 2021 ConsumerStyles survey. Respondents with a driver's license were asked whether they drove right after their most serious mTBI, how safe they felt driving, and whether a doctor or nurse talked to them about when it was ok to drive after their injury. RESULTS About one in five (18.8 %) respondents reported sustaining an mTBI in their lifetime. Twenty-two percent (22.3 %) of those with a driver's license at the time of their most serious mTBI drove within 24 h, and 20 % felt very or somewhat unsafe doing so. About 19 % of drivers reported that a doctor or nurse talked to them about when it was safe to return to driving. Those who had a healthcare provider talk to them about driving were 66 % less likely to drive a car within 24 h of their most serious mTBI (APR = 0.34, 95 % CI: 0.20, 0.60) compared to those who did not speak to a healthcare provider about driving. CONCLUSIONS Increasing the number of healthcare providers who discuss safe driving practices after a mTBI may reduce acute post-mTBI driving. PRACTICAL APPLICATIONS Inclusion of information in patient discharge instructions and prompts for healthcare providers in electronic medical records may help encourage conversations about post-mTBI driving.
Collapse
Affiliation(s)
- Jill Daugherty
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Highway NE MS S106-9, Atlanta, GA 30307, USA.
| | - Kelly Sarmiento
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Highway NE MS S106-9, Atlanta, GA 30307, USA
| | - Dana Waltzman
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Injury Prevention, 4770 Buford Highway NE MS S106-9, Atlanta, GA 30307, USA
| | - Julianne Schmidt
- University of Georgia Concussion Research Laboratory, Department of Kinesiology, 110 Carlton Street, Athens, GA 30602, USA
| |
Collapse
|
11
|
Schmitz B, Smulligan KL, Wingerson MJ, Walker GA, Wilson JC, Howell DR. Double Vision and Light Sensitivity Symptoms are Associated With Return-to-School Timing After Pediatric Concussion. Clin J Sport Med 2023; 33:264-269. [PMID: 36395518 DOI: 10.1097/jsm.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the association between academic time loss postconcussion and vision symptoms/impairments among pediatric patients. DESIGN Cross-sectional. SETTING Sports medicine clinic. PATIENTS Pediatric patients seen for care in a sports medicine clinic between the ages 6 and 18 years (n = 212; mean age = 14.3, SD = 2.4 years; 48% female) were evaluated within 21 days of concussion (mean = 9.8, SD = 5.7 days). INDEPENDENT VARIABLE Patients were grouped based on academic time loss (missed >5 days vs ≤5 days of school) at their initial postconcussion evaluation. OUTCOME MEASURES Patients rated concussion symptoms using the Health and Behavior Inventory (HBI) and underwent near point of convergence (NPC) testing. We compared groups on specific HBI symptom ratings of dizziness, blurry vision, seeing double, and light sensitivity, as well as NPC break and recovery point distances. RESULTS Two hundred twelve patients were included; n = 36 (17%) who reported missing >5 days of school. After adjusting for time since injury, parental education level, mechanism of injury, and preinjury anxiety, patients who reported missing >5 days of school had higher ratings of double vision (β = 0.27; 95% confidence interval [CI], 0.01-0.53; P = 0.04) and light sensitivity (β = 0.506; 95% CI, 0.061-0.951; P = 0.02), but not dizziness (β = 0.390; 95% CI, -0.047 to 0.827; P = 0.08) or blurry vision (β = 0.026; 95% CI, -0.352 to 0.404; P = 0.89). CONCLUSION Missing >5 days of school was associated with worse double vision and light sensitivity symptoms. Given the importance of vision in learning, assessing postconcussion vision symptoms may facilitate a successful return to school. Clinicians should assess a wide spectrum of vision-specific symptoms to ensure appropriate support during the return-to-school process.
Collapse
Affiliation(s)
- Baylie Schmitz
- Doctor of Occupational Therapy Program, Northern Arizona University, Phoenix, Arizona
| | - Katherine L Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Mathew J Wingerson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado
| | - Gregory A Walker
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado
| | - Julie C Wilson
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado
- Department of Pediatrics, University of Colorado School of Medicine, Colorado
| | - David R Howell
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
- Sports Medicine Center, Children's Hospital Colorado, Aurora, Colorado
| |
Collapse
|
12
|
Marzolla MC, Wijenberg M, Stapert S, Hurks P, Schepers J, van Heugten C. Hypersensitivity to Noise and Light Over 1 Year After Mild Traumatic Brain Injury: A Longitudinal Study on Self-Reported Hypersensitivity and Its Influence on Long-Term Anxiety, Depression, and Quality of Life. J Head Trauma Rehabil 2023; 38:259-267. [PMID: 35997762 DOI: 10.1097/htr.0000000000000813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate (1) the prevalence of self-reported sensory hypersensitivity (noise [NS] and light [LS]) over 1 year after mild traumatic brain injury (mTBI) in adults and (2) the impact of NS and LS measured 2 weeks after injury on long-term outcomes 12 months postinjury, while controlling for postconcussion symptoms. SETTING Participants were recruited from 6 hospitals in the south of the Netherlands and were tested 4 times (2 weeks, 3 months, 6 months, and 12 months postinjury), using self-report questionnaires. PARTICIPANTS In total, 186 mTBI participants (diagnosed using WHO [World Health Organization]/EFNS [European Federation of Neurological Societies] criteria at the neurology/emergency department) and 181 participants with a minor orthopedic injury in their extremities (control group). DESIGN An observational, longitudinal, multicenter cohort study. MAIN MEASURES NS and LS items (Rivermead Post-Concussion Symptoms Questionnaire) were used as main outcome variables to determine sensory hypersensitivity symptoms. Additional outcomes included anxiety, depression, health-related quality of life (HRQoL), and life satisfaction. RESULTS There was an elevated prevalence of NS and LS between 2 weeks and 3 months after injury in the mTBI group compared with controls. Approximately 3% of mTBI patients had persistent hypersensitivity symptoms during the whole course of the study. At 12 months postinjury, the mTBI and control groups did not differ in the prevalence of persistent hypersensitivity symptoms. There was no evidence of a predictive value of hypersensitivity within 2 weeks postinjury on anxiety, depression, HRQoL, or life satisfaction, 12 months later after controlling for postconcussion symptoms. CONCLUSIONS These results not only confirm the presence of hypersensitivity symptoms after mTBI in the subacute stage but also provide assurance about the small size of the group that experiences persistent symptoms. Furthermore, there was no evidence that early NS and LS are uniquely associated with long-term emotional and quality-of-life outcomes, over and above general levels of postconcussion symptoms.
Collapse
Affiliation(s)
- Marilien C Marzolla
- Department of Neuropsychology and Psychopharmacology (Ms Marzolla and Drs Stapert, Hurks, and van Heugten), Section of Teaching and Innovation of Learning (Dr Wijenberg), and Department of Methodology and Statistics (Dr Schepers), Faculty of Psychology and Neuroscience, and Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (Dr van Heugten), Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Centre, Maastricht, the Netherlands (Ms Marzolla and Dr van Heugten); Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands (Dr Wijenberg); and Department of Clinical and Medical Psychology, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands (Dr Stapert)
| | | | | | | | | | | |
Collapse
|
13
|
Temkin N, Machamer J, Dikmen S, Nelson LD, Barber J, Hwang PH, Boase K, Stein MB, Sun X, Giacino J, McCrea MA, Taylor SR, Jain S, Manley G. Risk Factors for High Symptom Burden Three Months after Traumatic Brain Injury and Implications for Clinical Trial Design: A Transforming Research and Clinical Knowledge in Traumatic Brain Injury Study. J Neurotrauma 2022; 39:1524-1532. [PMID: 35754333 PMCID: PMC9689769 DOI: 10.1089/neu.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
More than 75% of patients presenting to level I trauma centers in the United States with suspicion of TBI sufficient to require a clinical computed tomography scan report injury-related symptoms 3 months later. There are currently no approved treatments, and few clinical trials have evaluated possible treatments. Efficient trials will require subject inclusion and exclusion criteria that balance cost-effective recruitment with enrolling individuals with a higher chance of benefiting from the interventions. Using data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, we examined the relationship of 3-month symptoms to pre-injury, demographic, and acute characteristics as well as 2-week symptoms and blood-based biomarkers to identify and evaluate factors that may be used for sample enrichment for clinical trials. Many of the risk factors for TBI symptoms reported in the literature were supported, but the effect sizes of each were small or moderate (< 0.5). The only factors with large effect sizes when predicting 3-month symptom burden were TBI-related (i.e., post-concussive) and post-traumatic stress symptom levels at 2 weeks (respective effect sizes 1.13 and 1.34). TBI severity was not significantly associated with 3-month symptom burden (p = 0.37). Using simulated data to evaluate the effect of enrichment, we showed that including only people with high symptom burden at 2 weeks would permit trials to reduce the sample size by half, with minimal increase in screening, as compared with enrolling an unenriched sample. Clinical trials aimed at reducing symptoms after TBI can be efficiently conducted by enriching the included sample with people reporting a high early symptom burden.
Collapse
Affiliation(s)
- Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Joan Machamer
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sureyya Dikmen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Lindsay D. Nelson
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason Barber
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Phillip H. Hwang
- Department of Anatomy and Neurobiology, Boston University, Boston Massachusetts, USA
| | - Kim Boase
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Murray B. Stein
- Department of Psychiatry and Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - Xiaoying Sun
- Biostatistics Research Center Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - Joseph Giacino
- Department of Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
| | - Michael A. McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sabrina R. Taylor
- Brain and Spinal Injury Center, San Francisco California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Sonia Jain
- Biostatistics Research Center Herbert Wertheim School of Public Health, University of California, San Diego, California, USA
| | - Geoff Manley
- Brain and Spinal Injury Center, San Francisco California, USA
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| |
Collapse
|
14
|
Kaldenberg J, Newman R, Jimenez C, Walker M. Filter Interventions to Support Occupational Performance for People With Traumatic Brain Injury With Visual Symptoms (June 2013-October 2020). Am J Occup Ther 2022; 76:23926. [PMID: 36166580 DOI: 10.5014/ajot.2022/76s2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of filter interventions that address visual impairments and visual perception to improve occupational performance for adults with traumatic brain injury.
Collapse
Affiliation(s)
- Jennifer Kaldenberg
- Jennifer Kaldenberg, DrPH, MSA, OTR/L, SCLV, FAOTA, is Interim OTD Program Director and Clinical Associate Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Robin Newman
- Robin Newman, OTD, MA, OTR/L, CLT, FAOTA, is Clinical Assistant Professor, Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Christine Jimenez
- Christine Jimenez, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| | - Mary Walker
- Mary Walker, OTS, is a graduate student at Boston University College of Health & Rehabilitation Sciences: Sargent College
| |
Collapse
|
15
|
Ochi R, Saito S, Hiromitsu K, Shigemune Y, Shinoura N, Yamada R, Midorikawa A. Sensory hypo- and hypersensitivity in patients with brain tumors. Brain Inj 2022; 36:1053-1058. [PMID: 35971300 DOI: 10.1080/02699052.2022.2110943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Hyper- and hyposensitivity in multiple modalities have been well-documented in subjects with autistic spectrum disorder (ASD) but not in subjects with acquired brain injury (ABI). The purpose of this study was to determine whether subjects with ABI experience altered sensory processing in multiple sensory modalities, and to examine the relationships between impaired sensory processing and the emotional state. METHODS AND PROCEDURES Sixty-eight patients with brain or spinal cord tumors participated in the study. Cognitive ability and emotional function were tested, and subjective changes were evaluated in two directions (hyper- and hyposensitivity) and five modalities (visual, auditory, tactile, olfactory, and gustatory) at two time points (after disease onset and after surgery). RESULTS One-fifth of the participants complained of hypersensitivity in the visual domain, and a similar proportion complained of hyposensitivity in the auditory and tactile domains. Additionally, one-third of participants complained of two or more sensory abnormalities after disease onset. A hierarchical regression analysis indicated that auditory and tactile sensory changes predicted a depressive state. CONCLUSION In conclusion, multimodal sensory changes occurred in patients with brain tumors, manifesting as hyper- or hyposensitivity. Sensory changes might be related to depressive state, but the results were inconclusive.
Collapse
Affiliation(s)
- Ryuta Ochi
- Department of Psychology, Graduate School of Letters, Chuo University, Tokyo, Japan
| | - Shoko Saito
- Department of Psychology, Graduate School of Letters, Chuo University, Tokyo, Japan
| | - Kentaro Hiromitsu
- Department of Psychology, Graduate School of Letters, Chuo University, Tokyo, Japan
| | | | - Nobusada Shinoura
- Department of Neurosurgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Ryoji Yamada
- Department of Neurosurgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Akira Midorikawa
- Department of Psychology, Chuo University, Tokyo, Japan.,Department of Psychology, Faculty of Letters, Chuo University, Tokyo, Japan
| |
Collapse
|
16
|
Rauchman SH, Albert J, Pinkhasov A, Reiss AB. Mild-to-Moderate Traumatic Brain Injury: A Review with Focus on the Visual System. Neurol Int 2022; 14:453-470. [PMID: 35736619 PMCID: PMC9227114 DOI: 10.3390/neurolint14020038] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
Traumatic Brain Injury (TBI) is a major global public health problem. Neurological damage from TBI may be mild, moderate, or severe and occurs both immediately at the time of impact (primary injury) and continues to evolve afterwards (secondary injury). In mild (m)TBI, common symptoms are headaches, dizziness and fatigue. Visual impairment is especially prevalent. Insomnia, attentional deficits and memory problems often occur. Neuroimaging methods for the management of TBI include computed tomography and magnetic resonance imaging. The location and the extent of injuries determine the motor and/or sensory deficits that result. Parietal lobe damage can lead to deficits in sensorimotor function, memory, and attention span. The processing of visual information may be disrupted, with consequences such as poor hand-eye coordination and balance. TBI may cause lesions in the occipital or parietal lobe that leave the TBI patient with incomplete homonymous hemianopia. Overall, TBI can interfere with everyday life by compromising the ability to work, sleep, drive, read, communicate and perform numerous activities previously taken for granted. Treatment and rehabilitation options available to TBI sufferers are inadequate and there is a pressing need for new ways to help these patients to optimize their functioning and maintain productivity and participation in life activities, family and community.
Collapse
Affiliation(s)
- Steven H. Rauchman
- The Fresno Institute of Neuroscience, Fresno, CA 93730, USA
- Correspondence:
| | - Jacqueline Albert
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
| | - Aaron Pinkhasov
- Department of Psychiatry, NYU Long Island School of Medicine, Mineola, NY 11501, USA;
| | - Allison B. Reiss
- Department of Medicine, Biomedical Research Institute, NYU Long Island School of Medicine, Mineola, NY 11501, USA; (J.A.); (A.B.R.)
| |
Collapse
|
17
|
Theis J. Differential diagnosis and theories of pathophysiology of post-traumatic photophobia: A review. NeuroRehabilitation 2022; 50:309-319. [DOI: 10.3233/nre-228014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Photophobia is a common sensory symptom after traumatic brain injury (TBI) that may have a grave impact on a patient’s functional independence, neurorehabilitation, and activities of daily living. Post-TBI photophobia can be difficult to treat and the majority of patients can suffer chronically up to and beyond one year after their injury. OBJECTIVES: This review evaluates the current theories of the pathophysiology of photophobia and the most-common co-morbid etiologies of light sensitivity in TBI to help guide the differential diagnosis and individualized management of post-TBI photophobia. METHODS: Primary articles were found via PubMed and Google Scholar search of key terms including “photophobia” “light sensitivity” “photosensitivity” “photo-oculodynia” “intrinsically photosensitive retinal ganglion cells” “ipRGC” and “concussion” “brain injury” “dry eye”. Due to paucity of literature papers were reviewed from 1900 to present in English. RESULTS: Recent advances in understanding the pathophysiology of photophobia in dry eye and migraine and their connection to intrinsically photosensitive retinal ganglion cells (ipRGC) have revealed complex and multifaceted trigeminovascular and trigeminoautonomic pathways underlying photophobia. Patients who suffer a TBI often have co-morbidities like dry eye and migraine that may influence the patient’s photophobia. CONCLUSION: Post-traumatic photophobia is a complex multi-disciplinary complaint that can severely impact a patient’s quality of life. Exploration of underlying etiology may allow for improved treatment and symptomatic relief for these patients beyond tinted lenses alone.
Collapse
Affiliation(s)
- Jacqueline Theis
- Concussion Care Centre of Virginia, Richmond, VA, USA
- Virginia Neuro-Optometry, Richmond, VA, USA Tel.: +1 804 387 2902; Fax: +1 804 509 0543; E-mail:
| |
Collapse
|
18
|
Abstract
BACKGROUND: Post-traumatic headache is the most common sequela of brain injury and can last months or years after the damaging event. Many headache types are associated with visual concerns also known to stem from concussion. OBJECTIVES: To describe the various headache types seen after head injury and demonstrate how they impact or are impacted by the visual system. METHODS: We will mirror the International Classification of Headache Disorders (ICHD) format to demonstrate the variety of headaches following brain injury and relate correlates to the visual pathways. The PubMed database was searched using terms such as headache, head pain, vision, concussion, traumatic brain injury, glare, visuomotor pathways. RESULTS: Every type of headache described in the International Classification of Headache Disorders Edition III can be initiated or worsened after head trauma. Furthermore, there is very often a direct or indirect impact upon the visual system for each of these headaches. CONCLUSION: Headaches of every described type in the ICHD can be caused by brain injury and all are related in some way to the afferent, efferent or association areas of the visual system.
Collapse
Affiliation(s)
- Patrick T. Quaid
- Head of Optometry, VUE Cubed Vision Therapy Clinics, ON, Canada
- College of Optometrists of Ontario (Regulatory Body), ON, Canada
| | - Eric L. Singman
- Ophthalmology & Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
- Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
19
|
Abstract
BACKGROUND Although patients with abnormal light sensitivity may present to an ophthalmologist or optometrist for the evaluation of photophobia, there are no previous reviews of the most common causes of this symptom. METHODS We conducted a retrospective chart review of patients who presented to our eye center between 2001 and 2009 primarily for the evaluation of photophobia. We recorded demographics, ocular examination findings, and diagnoses of these patients. RESULTS Our population included 58 women and 53 men. The mean age at presentation to the clinic was 37 years (range 6 months-94 years). The most frequent cause of photophobia was migraine headache (53.7%), followed by dry eye syndrome (36.1), ocular trauma (8.2%), progressive supranuclear palsy (6.8%), and traumatic brain injury (4.1%). A significant proportion of patients (25.9%) left the clinic without a cause for their photophobia documented by the examining physician (11.7% of adults and 69.4% of children). CONCLUSIONS Photophobia affects patients of all ages, and many patients are left without a specific diagnosis, indicating a significant knowledge gap among ophthalmologists and optometrists evaluating these patients.
Collapse
|
20
|
Faulkner JW, Snell DL, Shepherd D, Theadom A. Turning away from sound: The role of fear avoidance in noise sensitivity following mild traumatic brain injury. J Psychosom Res 2021; 151:110664. [PMID: 34749069 DOI: 10.1016/j.jpsychores.2021.110664] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Noise sensitivity (NS) following mild traumatic brain injury (mTBI) is common impacts functioning and outcomes. Recent research suggests psychological factors may have a significant role in the development of NS after mTBI. Psychological interventions have been advocated for to reduce this experience. To be effective, these interventions must aim to target the psychological processes that contribute to this relationship. Fear avoidance holds promise in this regard. The current study aimed to explore the role of fear avoidance in NS and examine its role in mediating the relationship between psychological distress and NS. METHOD Adults (n = 234) diagnosed with mTBI were recruited from outpatient mTBI clinics throughout New Zealand. Participants completed self-report measures of pre-injury mental health status, as well as current post-concussion symptoms, psychological distress (anxiety, stress, depression, fear avoidance and post-traumatic stress symptoms) and functional status upon entry to an mTBI outpatient clinic (M = 8.9, SD = 9.2, post injury). RESULTS A pre-injury mental health diagnosis was associated with NS after mTBI, as were symptoms of anxiety, stress, depression, and post-traumatic stress. Regression analyses revealed that fear avoidance (β = 0.45, p = .01), as well as stress (β = 0.07, p = .01) and PTSD symptoms (β = 0.02, p = .01), made a significant and unique contribution to NS. A series of mediation analyses found that fear avoidance had a significant indirect effect on the relationships between psychological distress and NS. CONCLUSIONS Fear avoidance is related to NS following mTBI. Targeting fear avoidance behaviours and beliefs may represent a treatment target for reducing NS after mTBI.
Collapse
Affiliation(s)
- Josh W Faulkner
- Massey University, PO Box 756, Wellington 6140, New Zealand.
| | - Deborah L Snell
- University of Otago Christchurch, 2 Riccarton Ave, Christchurch 8011, New Zealand
| | - Daniel Shepherd
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| | - Alice Theadom
- TBI Network, Auckland University of Technology, University of Technology, 90 Akoranga Drive, Northcote, Auckland, New Zealand
| |
Collapse
|
21
|
Anderson KS, Gosselin N, Sadikot AF, Laguë-Beauvais M, Kang ESH, Fogarty AE, Marcoux J, Dagher J, de Guise E. Pitch and Rhythm Perception and Verbal Short-Term Memory in Acute Traumatic Brain Injury. Brain Sci 2021; 11:1173. [PMID: 34573194 PMCID: PMC8469559 DOI: 10.3390/brainsci11091173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/25/2022] Open
Abstract
Music perception deficits are common following acquired brain injury due to stroke, epilepsy surgeries, and aneurysmal clipping. Few studies have examined these deficits following traumatic brain injury (TBI), resulting in an under-diagnosis in this population. We aimed to (1) compare TBI patients to controls on pitch and rhythm perception during the acute phase; (2) determine whether pitch and rhythm perception disorders co-occur; (3) examine lateralization of injury in the context of pitch and rhythm perception; and (4) determine the relationship between verbal short-term memory (STM) and pitch and rhythm perception. Music perception was examined using the Scale and Rhythm tests of the Montreal Battery of Evaluation of Amusia, in association with CT scans to identify lesion laterality. Verbal short-term memory was examined using Digit Span Forward. TBI patients had greater impairment than controls, with 43% demonstrating deficits in pitch perception, and 40% in rhythm perception. Deficits were greater with right hemisphere damage than left. Pitch and rhythm deficits co-occurred 31% of the time, suggesting partly dissociable networks. There was a dissociation between performance on verbal STM and pitch and rhythm perception 39 to 42% of the time (respectively), with most individuals (92%) demonstrating intact verbal STM, with impaired pitch or rhythm perception. The clinical implications of music perception deficits following TBI are discussed.
Collapse
Affiliation(s)
- Kirsten S Anderson
- Psychology Department, University of Montreal, Montreal, QC H2V 2S9, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montreal, QC H3S 1M9, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), and Centre for Research on Brain, Language, and Music (CRBLM), Montreal, QC H2V2S9, Canada
| | - Nathalie Gosselin
- Psychology Department, University of Montreal, Montreal, QC H2V 2S9, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), and Centre for Research on Brain, Language, and Music (CRBLM), Montreal, QC H2V2S9, Canada
| | - Abbas F Sadikot
- Neurology and Neurosurgery Department, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| | - Maude Laguë-Beauvais
- Neurology and Neurosurgery Department, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Traumatic Brain Injury Program, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Esther S H Kang
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada
| | - Alexandra E Fogarty
- Department of Neurology, Division of Physical Medicine and Rehabilitation, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Judith Marcoux
- Neurology and Neurosurgery Department, McGill University Health Centre, Montreal, QC H4A 3J1, Canada
- Traumatic Brain Injury Program, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Jehane Dagher
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montreal, QC H3S 1M9, Canada
- Traumatic Brain Injury Program, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Elaine de Guise
- Psychology Department, University of Montreal, Montreal, QC H2V 2S9, Canada
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montreal, QC H3S 1M9, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC H4A 3J1, Canada
| |
Collapse
|
22
|
Grima NA, Rajaratnam SMW, Mansfield D, McKenzie D, Ponsford JL. Poorer sleep quality predicts melatonin response in TBI patients: findings from a randomized controlled trial. J Clin Sleep Med 2021; 17:1545-1551. [PMID: 33704046 DOI: 10.5664/jcsm.9234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES A recent clinical trial demonstrated that melatonin treatment was effective in improving self-perceived sleep quality in patients with TBI; however, it remains unclear which patients benefited from melatonin treatment. To that end, findings from the clinical trial were re-examined to identify possible predictors of treatment response. METHODS Hierarchical multiple regression was utilized to identify patient characteristics, TBI injury characteristics, and self-report measures assessing sleep, fatigue, mood, and anxiety symptomatology that may uniquely explain a change in self-reported sleep quality scores (follow-up minus baseline score) as assessed by the Pittsburgh Sleep Quality Index(PSQI). RESULTS After controlling for patient demographic and TBI injury-related variables, baseline self-report measures of sleep, fatigue, mood, and anxiety explained an additional 32% of the variance in change in PSQI scores. However, only baseline PSQI score made a unique and statistically significant contribution (β = -.56, p = .006). After controlling for patient and TBI characteristics, baseline PSQI scores further explained 27% of the variance in change in PSQI scores, R squared change = .27, F change (1, 27) = 11.79, p = .002). The standardized beta for baseline PSQI score revealed a statistically significant negative relationship with change in PSQI score (β = -.54, p = .002) revealing that higher PSQI score at baseline was associated with better sleep outcomes. CONCLUSIONS In a sample comprising predominately severe TBI and comorbid insomnia, participants who report poorer sleep quality have the most to gain from melatonin treatment irrespective of time since injury, demographics, fatigue, daytimes sleepiness, mood, and anxiety symptomology. CLINICAL TRIAL REGISTRATION The manuscript reports on a clinical trial which was prospectively registered with the Australian New Zealand Clinical Trials Registry on the 13th of July, 2011. Identifier: ACTRN12611000734965 https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343083&showOriginal=true&isReview=true.
Collapse
Affiliation(s)
- Natalie A Grima
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia
| | - Shantha M W Rajaratnam
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia
| | - Darren Mansfield
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia.,Monash Lung and Sleep, Monash Health, Clayton, VIC, Australia
| | - Dean McKenzie
- Epworth HealthCare, Richmond, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, St. Kilda, VIC, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Epworth HealthCare, Richmond, VIC, Australia.,Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton Campus, Clayton, VIC, Australia
| |
Collapse
|
23
|
Sarmiento K, Waltzman D, Wright D. Do healthcare providers assess for risk factors and talk to patients about return to driving after a mild traumatic brain injury (mTBI)? Findings from the 2020 DocStyles Survey. Inj Prev 2021; 27:560-566. [PMID: 33452014 DOI: 10.1136/injuryprev-2020-044034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There is a dearth of information and guidance for healthcare providers on how to manage a patient's return to driving following a mild traumatic brain injury (mTBI). METHODS Using the 2020 DocStyles survey, 958 healthcare providers were surveyed about their diagnosis and management practices related to driving after an mTBI. RESULTS Approximately half (52.0%) of respondents reported routinely (more than 75% of the time) talking with patients with mTBI about how to safely return to driving after their injury. When asked about how many days they recommend their patients with mTBI wait before returning to driving after their injury: 1.0% recommended 1 day or less; 11.7% recommended 2-3 days; 24.5% recommended 4-7 days and 45.9% recommended more than 7 days. Many respondents did not consistently screen patients with mTBI for risk factors that may affect their driving ability or provide them with written instructions on how to safely return to driving (59.7% and 62.6%, respectively). Approximately 16.8% of respondents reported they do not usually make a recommendation regarding how long patients should wait after their injury to return to driving. CONCLUSIONS Many healthcare providers in this study reported that they do not consistently screen nor educate patients with mTBI about driving after their injury. In order to develop interventions, future studies are needed to assess factors that influence healthcare providers behaviours on this topic.
Collapse
Affiliation(s)
- Kelly Sarmiento
- National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | - Dana Waltzman
- National Center for Injury Prevention and Control, Division of Injury Prevention, Atlanta, Georgia, USA
| | - David Wright
- Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
24
|
Guedes VA, Devoto C, Leete J, Sass D, Acott JD, Mithani S, Gill JM. Extracellular Vesicle Proteins and MicroRNAs as Biomarkers for Traumatic Brain Injury. Front Neurol 2020; 11:663. [PMID: 32765398 PMCID: PMC7378746 DOI: 10.3389/fneur.2020.00663] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/02/2020] [Indexed: 12/12/2022] Open
Abstract
Traumatic brain injury (TBI) is a heterogeneous condition, associated with diverse etiologies, clinical presentations and degrees of severity, and may result in chronic neurobehavioral sequelae. The field of TBI biomarkers is rapidly evolving to address the many facets of TBI pathology and improve its clinical management. Recent years have witnessed a marked increase in the number of publications and interest in the role of extracellular vesicles (EVs), which include exosomes, cell signaling, immune responses, and as biomarkers in a number of pathologies. Exosomes have a well-defined lipid bilayer with surface markers that reflect the cell of origin and an aqueous core that contains a variety of biological material including proteins (e.g., cytokines and growth factors) and nucleic acids (e.g., microRNAs). The presence of proteins associated with neurodegenerative changes such as amyloid-β, α-synuclein and phosphorylated tau in exosomes suggests a role in the initiation and propagation of neurological diseases. However, mechanisms of cell communication involving exosomes in the brain and their role in TBI pathology are poorly understood. Exosomes are promising TBI biomarkers as they can cross the blood-brain barrier and can be isolated from peripheral fluids, including serum, saliva, sweat, and urine. Exosomal content is protected from enzymatic degradation by exosome membranes and reflects the internal environment of their cell of origin, offering insights into tissue-specific pathological processes. Challenges in the clinical use of exosomal cargo as biomarkers include difficulty in isolating pure exosomes, variable yields of the isolation processes, quantification of vesicles, and lack of specificity of exosomal markers. Moreover, there is no consensus regarding nomenclature and characteristics of EV subtypes. In this review, we discuss current technical limitations and challenges of using exosomes and other EVs as blood-based biomarkers, highlighting their potential as diagnostic and prognostic tools in TBI.
Collapse
Affiliation(s)
- Vivian A Guedes
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Christina Devoto
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jacqueline Leete
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Delia Sass
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jedidiah D Acott
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Sara Mithani
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| |
Collapse
|
25
|
Han B. Associations between perceived environmental pollution and health-related quality of life in a Chinese adult population. Health Qual Life Outcomes 2020; 18:198. [PMID: 32576182 PMCID: PMC7310336 DOI: 10.1186/s12955-020-01442-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) measures are being used in increasingly diverse populations. However, there have no known studies to date to examine the associations between perceived environmental pollution and HRQoL in a Chinese population. This study aimed to report the associations between air, water, noise pollution and HRQoL among Chinese adult population. METHODS A cross-sectional survey data was used from East Asian Social Survey 2010 with a sample of 3866 Chinese populations regarding environmental pollution. HRQoL was computed by SF-12 and reflected by physical and mental component summary score (PCS & MCS). Ordinary least regression analyses were used to examine associations between perceived environmental pollution and PCS and MCS scores. Models in SPSS PROCESS were selected to demonstrate the moderating and mediating effects. RESULTS Only considering one pollutant, perceived air pollution and perceived water pollution had significant associations with PCS and MCS scores. Perceived noise pollution had significant associations with PCS scores. Perceived air×noise, air×water, noise×water, and air×noise×water pollution had significant associations with PCS and MCS scores. Conditional (moderated) mediation showed that there were no moderating effects and mediating effects of perceived one pollutant on another pollutant. CONCLUSIONS Co-occurring perceived environmental pollution were mainly associated with progressive increase in PCS and MCS scores among the Chinese adult population. These results suggested that some effective policies should be carried out to improve environmental quality in Chinese adult population.
Collapse
Affiliation(s)
- Bingxue Han
- International Issues Center, Xuchang University, Xuchang, Henan, China. .,Family Issues Center, Xuchang University, Xuchang, Henan, China. .,Xuchang Urban Water Pollution Control and Ecological Restoration Engineering Technology Research Center, Xuchang University, Xuchang, China. .,College of Urban and Environmental Sciences, Xuchang University, Xuchang, China.
| |
Collapse
|